Multiple Anterior Mitral Valve Perforation After Deep Transfemoral Aortic Valve Implantation

Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative for high-risk aortic valve replacement. There are limited data related to the late complications of TAVI. Deep aortic prosthetic valve implantation can cause direct erosive perforation of anterior mitral leaflet or erosive endothelial lesion which predisposes the tissue to infective endocarditis. Our report emphasizes anterior mitral leaflet perforation after TAVI, which may be seen especially in patients exposed to sepsis.

Interference between Venus-A Valve and Anterior Mitral Valve Leaflets after Transcatheter Aortic Valve Replacement: Insight from FEops HEARTguide simulation

“…Regarding clinical outcomes, no significant differences were observed in aortic flow velocity, aortic pressure gradient, or clinical events such as mortality, stroke, PVL, and heart failure between the two groups at both the 30-day and 12-month follow-ups. In particular, we observed special adverse consequences of PAI according to previous reports (3)(4)(5)(6), and no new-onset mitral stenosis, infective endocarditis, or mitral valve perforation occurred in either group (Table 3).…”

“…As the anterior mitral annulus is anatomically linked to both the left and non-coronary aortic cusps through a shared fibrous rim (2), the prosthesis frame mechanically interferes with the anterior mitral leaflet (AML), especially when implanted in a low position. Several case reports have reported that deep aortic prosthetic valve implantation may impair adequate AML opening (3,4), even led to direct erosive perforation and infective endocarditis (5)(6)(7). However, the existing knowledge about this rarely described complication remains limited.…”